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Striano BM, Crawford AM, Verhofste BP, Hresko AM, Hedequist DJ, Schoenfeld AJ, Simpson AK. Intraoperative navigation increases the projected lifetime cancer risk in patients undergoing surgery for adolescent idiopathic scoliosis. Spine J 2024; 24:1087-1094. [PMID: 38262498 DOI: 10.1016/j.spinee.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND CONTEXT Adolescent idiopathic scoliosis (AIS) is a common condition, often requiring surgical correction. Computed tomography (CT) based navigation technologies, which rely on ionizing radiation, are increasingly being utilized for surgical treatment. Although this population is highly vulnerable to radiation, given their age and female predominance, there is little available information elucidating modeled iatrogenic cancer risk. PURPOSE To model lifetime cancer risk associated with the use of intraoperative CT-based navigation for surgical treatment of AIS. STUDY DESIGN/SETTING This retrospective cross-sectional study took place in a quaternary care academic pediatric hospital in the United States. PATIENT SAMPLE Adolescents aged 10-18 who underwent posterior spinal fusion for a diagnosis of AIS between July 2014 and December 2019. OUTCOMES MEASURES Effective radiation dose and projected lifetime cancer risk associated with intraoperative doses of ionizing radiation. METHODS Clinical and radiographic parameters were abstracted, including total radiation dose during surgery from flat plate radiographs, fluoroscopy, and intraoperative CT scans. Multivariable regression analysis was used to assess differences in radiation exposure between patients treated with conventional radiography versus intraoperative navigation. Radiation exposure was translated into lifetime cancer risk using well-established algorithms. RESULTS In total, 245 patients were included, 119 of whom were treated with navigation. The cohort was 82.9% female and 14.4 years of age. The median radiation exposure (in millisieverts, mSv) for fluoroscopy, radiography, and navigation was 0.05, 4.14, and 8.19 mSv, respectively. When accounting for clinical and radiographic differences, patients treated with intraoperative navigation received 8.18 mSv more radiation (95%CI: 7.22-9.15, p<.001). This increase in radiation projects to 0.90 iatrogenic malignancies per 1,000 patients (95%CI 0.79-1.01). CONCLUSIONS Ours is the first work to define cancer risk in the setting of radiation exposure for navigated AIS surgery. We project that intraoperative navigation will generate approximately one iatrogenic malignancy for every 1,000 patients treated. Given that spine surgery for AIS is common and occurs in the context of a multitude of other radiation sources, these data highlight the need for radiation budgeting protocols and continued development of lower radiation dose technologies. LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Bram P Verhofste
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Andrew M Hresko
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA, USA
| | - Daniel J Hedequist
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew J Schoenfeld
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew K Simpson
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Balubaid RN, Aljedani RS, Moglan A, Hennawi YB, Mousa AH, Alosaimi M. Prevalence of spinal deformity development after surgical management of a congenital heart disease among children: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2088-2096. [PMID: 38466435 DOI: 10.1007/s00586-023-08083-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/04/2023] [Accepted: 12/01/2023] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Open heart surgery is the most common treatment for congenital heart disease. Thoracotomy, sternotomy, or a combination of both are the main approaches used in open heart surgeries. In cardiac surgery, there have been concerns that these surgeries increase the likelihood of spinal deformities. Therefore, this systematic review and meta-analysis provided updated evidence on the prevalence of spinal deformities following congenital heart surgery. METHOD EMBASE, Medline, ScienceDirect, and Google Scholar were used to search for studies published until 2022. We include randomized clinical trials and observational studies that reported the prevalence of spinal deformities (scoliosis and kyphosis) after congenital heart surgery among participants without these deformities before surgery. Two independent reviewers independently screened literature identified from the databases. Two reviewers independently conducted screening of studies identified during the search, data extraction, and quality assessment of the included studies. RESULTS In total, 688 studies were screened; 13 retrospective and one prospective cohort studies were included, encompassing 2294 participants. The pooled prevalence of spinal deformities (scoliosis and kyphosis) after open heart surgery performed on skeletally immature patients was 23.1% (95% confidence interval [CI] = 23.1-35.3; I2 = 97.5%). CONCLUSION This review suggests that the prevalence of spinal deformities was high among patients who underwent sternotomy or thoracotomy.
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Affiliation(s)
- Renad N Balubaid
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Raghd S Aljedani
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Abdulaziz Moglan
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Yasser B Hennawi
- Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Ahmed Hafez Mousa
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Majed Alosaimi
- College of Medicine, King Saud Bin Abdulaziz University For Health Sciences, Jeddah, Saudi Arabia.
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
- Department of Orthopedic, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
- King Khalid National Guard Hospital, King Abdulaziz Medical City, National Guard, Jeddah, Saudi Arabia.
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Yuan P, Wang ZH, Jiang H, Wang YH, Yang JY, Li LM, Wang WT, Chen J, Li DH, Long SY, Zhang W, He F, Wang WZ. Prevalence and plasma exosome-derive microRNA diagnostic biomarker screening of adolescent idiopathic scoliosis in Yunnan Province, China. Front Pediatr 2024; 12:1308931. [PMID: 38720947 PMCID: PMC11076730 DOI: 10.3389/fped.2024.1308931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/02/2024] [Indexed: 05/12/2024] Open
Abstract
Background Idiopathic scoliosis significantly affects the physical and mental health of children and adolescents, with varying prevalence rates in different regions. The occurrence of idiopathic scoliosis is associated with genetic regulation and biochemical factors, but the changes in exosome-derived miRNA profiles among idiopathic scoliosis patients remain unclear. This study aimed to determine the prevalence of idiopathic scoliosis in Yunnan Province, China, and identify key exosome-derived miRNAs in idiopathic scoliosis through a cohort study. Methods From January 2018 to December 2020, a cross-sectional study on idiopathic scoliosis in children and adolescents was conducted in Yunnan Province. A total of 84,460 students from 13 cities and counties in Yunnan Province participated in a scoliosis screening program, with ages ranging from 7 to 19 years. After confirmation through screening and imaging results, patients with severe idiopathic scoliosis and normal control individuals were selected using propensity matching. Subsequently, plasma exosome-derived miRNA sequencing and RT-qPCR validation were performed separately. Based on the validation results, diagnostic performance analysis and target gene prediction were conducted for differential plasma exosome-derived miRNAs. Results The overall prevalence of idiopathic scoliosis in children and adolescents in Yunnan Province was 1.10%, with a prevalence of 0.87% in males and 1.32% in females. The peak prevalence was observed at age 13. Among patients diagnosed with idiopathic scoliosis, approximately 12.8% had severe cases, and there were more cases of double curvature than of single curvature, with thoracolumbar curvature being the most common in the single-curvature group. Sequencing of plasma exosome-derived miRNAs associated with idiopathic scoliosis revealed 56 upregulated and 153 downregulated miRNAs. Further validation analysis confirmed that hsa-miR-27a-5p, hsa-miR-539-5p, and hsa-miR-1246 have potential diagnostic value. Conclusions We gained insights into the epidemiological characteristics of idiopathic scoliosis in Yunnan Province and conducted further analysis of plasma exosome-derived miRNA changes in patients with severe idiopathic scoliosis. This study has provided new insights for the prevention and diagnosis of idiopathic scoliosis, paving the way for exploring clinical biomarkers and molecular regulatory mechanisms. However, further validation and elucidation of the detailed biological mechanisms underlying these findings will be required in the future.
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Affiliation(s)
- Ping Yuan
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
| | - Zhi-Hua Wang
- Trauma Medicine Centre, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hong Jiang
- Department of Medical Imaging, Kunming Children’s Hospital, Kunming Medical University, Kunming, Yunnan, China
| | - Yang-Hao Wang
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
- Department of Pathology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Jian-Yi Yang
- Department of Orthopaedics, Kunming Guandu District People’s Hospital, Kunming, Yunnan, China
| | - Lu-Ming Li
- Department of Orthopedics, Yunnan Sino-German Orthopedic Hospital, Kunming, Yunnan, China
| | - Wen-Tong Wang
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
| | - Jing Chen
- Department of Pathology and Pathophysiology, Faculty of Basic Medical Science, Kunming Medical University, Kunming, Yunnan, China
| | - Deng-Hui Li
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
| | - Sheng-Yu Long
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
- Department of Orthopedic, Qujing Affiliated Hospital of Kunming Medical University, Qujing, Yunnan, China
| | - Wan Zhang
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
| | - Fei He
- Department of Orthopedic, Qujing Affiliated Hospital of Kunming Medical University, Qujing, Yunnan, China
| | - Wei-Zhou Wang
- Department of Orthopedics, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
- The First Clinical College, Kunming Medical University, Kunming, Yunnan, China
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Mastrokostas PG, Mastrokostas LE, Emara AK, Wellington IJ, Ginalis E, Houten JK, Khalsa AS, Saleh A, Razi AE, Ng MK. Modern Internet Search Analytics: Is There a Difference in What Patients are Searching Regarding the Operative and Nonoperative Management of Scoliosis? Global Spine J 2024:21925682241248110. [PMID: 38613478 DOI: 10.1177/21925682241248110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2024] Open
Abstract
STUDY DESIGN Observational Study. OBJECTIVES This study aimed to investigate the most searched types of questions and online resources implicated in the operative and nonoperative management of scoliosis. METHODS Six terms related to operative and nonoperative scoliosis treatment were searched on Google's People Also Ask section on October 12, 2023. The Rothwell classification was used to sort questions into fact, policy, or value categories, and associated websites were classified by type. Fischer's exact tests compared question type and websites encountered between operative and nonoperative questions. Statistical significance was set at the .05 level. RESULTS The most common questions concerning operative and nonoperative management were fact (53.4%) and value (35.5%) questions, respectively. The most common subcategory pertaining to operative and nonoperative questions were specific activities/restrictions (21.7%) and evaluation of treatment (33.3%), respectively. Questions on indications/management (13.2% vs 31.2%, P < .001) and evaluation of treatment (10.1% vs 33.3%, P < .001) were associated with nonoperative scoliosis management. Medical practice websites were the most common website to which questions concerning operative (31.9%) and nonoperative (51.4%) management were directed to. Operative questions were more likely to be directed to academic websites (21.7% vs 10.0%, P = .037) and less likely to be directed to medical practice websites (31.9% vs 51.4%, P = .007) than nonoperative questions. CONCLUSIONS During scoliosis consultations, spine surgeons should emphasize the postoperative recovery process and efficacy of conservative treatment modalities for the operative and nonoperative management of scoliosis, respectively. Future research should assess the impact of website encounters on patients' decision-making.
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Affiliation(s)
- Paul G Mastrokostas
- College of Medicine, State University of New York (SUNY) Downstate, Brooklyn, NY, USA
| | | | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Ian J Wellington
- Department of Orthopaedic Surgery, University of Connecticut, Hartford, CT, USA
| | | | - John K Houten
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA
| | - Amrit S Khalsa
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ahmed Saleh
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Afshin E Razi
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
| | - Mitchell K Ng
- Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, USA
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Larson AN, Polly DW, Sponseller PD, Kelly MP, Richards BS, Garg S, Parent S, Shah SA, Weinstein SL, Crawford CH, Sanders JO, Blakemore LC, Oetgen ME, Fletcher ND, Kremers WK, Marks MC, Brearley AM, Aubin CE, Sucato DJ, Labelle H, Erickson MA. The Effect of Implant Density on Adolescent Idiopathic Scoliosis Fusion: Results of the Minimize Implants Maximize Outcomes Randomized Clinical Trial. J Bone Joint Surg Am 2024; 106:180-189. [PMID: 37973031 DOI: 10.2106/jbjs.23.00178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Severe adolescent idiopathic scoliosis (AIS) can be treated with instrumented fusion, but the number of anchors needed for optimal correction is controversial. METHODS We conducted a multicenter, randomized study that included patients undergoing spinal fusion for single thoracic curves between 45° and 65°, the most common form of operatively treated AIS. Of the 211 patients randomized, 108 were assigned to a high-density screw pattern and 103, to a low-density screw pattern. Surgeons were instructed to use ≥1.8 implants per spinal level fused for patients in the high-implant-density group or ≤1.4 implants per spinal level fused for patients in the low-implant-density group. The primary outcome measure was the percent correction of the coronal curve at the 2-year follow-up. The power analysis for this trial required 174 patients to show equivalence, defined as a 95% confidence interval (CI) within a ±10% correction margin with a probability of 90%. RESULTS In the intention-to-treat analysis, the mean percent correction of the coronal curve was equivalent between the high-density and low-density groups at the 2-year follow-up (67.6% versus 65.7%; difference, -1.9% [95% CI: -6.1%, 2.2%]). In the per-protocol cohorts, the mean percent correction of the coronal curve was also equivalent between the 2 groups at the 2-year follow-up (65.0% versus 66.1%; difference, 1.1% [95% CI: -3.0%, 5.2%]). A total of 6 patients in the low-density group and 5 patients in the high-density group required reoperation (p = 1.0). CONCLUSIONS In the setting of spinal fusion for primary thoracic AIS curves between 45° and 65°, the percent coronal curve correction obtained with use of a low-implant-density construct and that obtained with use of a high-implant-density construct were equivalent. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - David W Polly
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | | | | | | | - Sumeet Garg
- Children's Hospital of Colorado, Aurora, Colorado
| | | | | | | | | | | | | | | | | | | | - Michelle C Marks
- Harms Study Group/Setting Scoliosis Straight Foundation, El Cajon, California
| | | | - Carl-Eric Aubin
- Ecole Polytechnique, St. Justine Hospital, Montreal, Quebec, Canada
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Sağlam Y, Bingöl I, Yaşar NE, Dumlupınar E, Ata N, Ülgü MM, Birinci Ş, Özdemir G, Aslantürk O, Görgün B. The burden of scoliosis: a nationwide database study on demographics, incidence, and surgical rates. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:655-662. [PMID: 37803157 DOI: 10.1007/s00586-023-07967-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION Scoliosis is characterized as a three-dimensional deformity of the spine, affected by variety of factors, including biological, mechanical, hormonal, and genetics. METHODS Our study's primary objective was to delineate the demographics, incidence, and prevalence of scoliosis from a nationwide perspective, analyze the surgical intervention rates, with the aim of offering more insightful guidance to orthopedic physicians. This nationwide cohort study was conducted from digital database for healthcare information management. Relevant population data, for children under 18 years old, was extracted from the official government census within the period of January 2015 to December 2022. Utilizing diagnostic code of M41 [Scoliosis] was used to define the patient pool from ICD-10. Demographic variables, type of operations (posterior only, anterior only, or combined), and complications were documented. Incidence and prevalence values were calculated using population figures and case numbers. RESULT There were 276,521 patients with an average incidence of 129 per 100,000. Frequency of females was 1.45 times greater than that of males (p < 0.001). A total of 10,417 surgeries were performed in 10,311 patients during the inspection period (3.8% of all cases). Posterior fusion was by far the most common surgical approach (n = 10.111; 97%) followed by anterior fusion (n = 200; 1,9%). CONCLUSIONS Our findings reveal a significant increase in the average incidence of scoliosis diagnosis, rising from 107 per 100,000 individuals in 2015 to 161 per 100,000 in 2022. Scoliosis now impacts an estimated 1.2% of children and adolescents in Turkey. The risk is 1.45 times higher in females than in males.
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Affiliation(s)
- Yavuz Sağlam
- Istanbul Faculty of Medicine, Orthopedics and Traumatology Department, Istanbul University, Istanbul, Turkey.
| | - Izzet Bingöl
- Faculty of Medicine, Ankara Onchology Training and Research Hospital, Health Sciences University, Ankara, Turkey
| | - Niyazi Erdem Yaşar
- Ankara Bilkent City Hospital, Department of Orthopaedics and Traumatology, Health Sciences University, Ankara, Turkey
| | - Ebru Dumlupınar
- Faculty of Medicine, Department of Biostatistics, Ankara University, Ankara, Turkey
| | - Naim Ata
- Ministry of Health, General Directorate of Health Information Systems, Ankara, Turkey
| | - M Mahir Ülgü
- General Directorate of Health Information Systems, Ankara, Turkey
| | | | - Güzelali Özdemir
- Faculty of Medicine, Ankara Bilkent City Hospital, Department of Orthopaedics and Traumatology, Health Sciences University, Ankara, Turkey
| | - Okan Aslantürk
- Faculty of Medicine, Department of Orthopaedics and Traumatology, Inonü University, Malatya, Turkey
| | - Barış Görgün
- Ortopediatri Istanbul, Academy of Children Orthopaedics, Istanbul, Turkey
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Nishimura T, Watanabe H, Taki N, Kikkawa I. The Proportion of Normalized Hips with Growth in Japanese Adolescents Aged > 10 years with Acetabular Dysplasia who Presented with Suspected Scoliosis. Indian J Orthop 2024; 58:169-175. [PMID: 38312899 PMCID: PMC10830976 DOI: 10.1007/s43465-023-01065-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/14/2023] [Indexed: 02/06/2024]
Abstract
Background If asymptomatic acetabular dysplasia (AD) is incidentally identified in adolescence, it is difficult to determine the appropriate follow-up or treatment strategy because the acetabulum is still developing. We investigated the rate of AD normalization at the end of acetabular growth. Methods This cross-sectional study involved 653 patients (1306 hips) aged 10-14 years with scoliosis or suspected scoliosis. All patients underwent plain standing whole-spine radiography (with the pelvis included) at the first visit. We measured the lateral center-edge angle, Sharp angle, Tönnis angle, and acetabular head index on radiographs. The criterion for AD was a lateral center-edge angle of < 20°. We extracted the data of patients aged < 12 (10-11) years and ≥ 12 (12-14) years with AD. Furthermore, we analyzed the radiographic follow-up data at 15 years of age to identify the AD normalization rate. Results AD was diagnosed in 19 hips from patients aged < 12 years and in 36 hips from patients aged ≥ 12 years. The AD normalization rate at 15 years of age was 31.6% in those diagnosed at < 12 years of age and 5.6% in those diagnosed at ≥ 12 years of age. Conclusion AD in adolescence was predictive of AD at the end of growth in 95% of cases diagnosed at ≥ 12 years of age compared with approximately 70% of cases diagnosed at < 12 years of age. Surgical treatment before completion of acetabular growth is beneficial for acetabular remodeling, but the decision to operate should be carefully evaluated in patients aged < 12 years. Graphical Abstract Supplementary Information The online version contains supplementary material available at 10.1007/s43465-023-01065-4.
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Affiliation(s)
- Takahiro Nishimura
- Department of Orthopedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Hideaki Watanabe
- Department of Pediatric Orthopedics and Orthopedic Surgery, Jichi Children’s Medical Center, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Naoya Taki
- Department of Pediatric Orthopedics and Orthopedic Surgery, Jichi Children’s Medical Center, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498 Japan
| | - Ichiro Kikkawa
- Department of Orthopedic Surgery, Nasu Central Hospital, 1453 Shimoishigami, Otawara, Tochigi, 324-0036 Japan
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Del Prete CM, Tarantino D, Viva MG, Murgia M, Vergati D, Barassi G, Sparvieri E, Di Stanislao E, Perpetuini D, Russo EF, Filoni S, Pellegrino R. Spinal Orthosis in Adolescent Idiopathic Scoliosis: An Overview of the Braces Provided by the National Health Service in Italy. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:3. [PMID: 38276037 PMCID: PMC10818494 DOI: 10.3390/medicina60010003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/06/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024]
Abstract
Adolescent idiopathic scoliosis (AIS) is a lateral, rotated curvature of the spine. It is a 3-dimensional deformity that arises in otherwise healthy children at or around puberty. AIS is the most common form of scoliosis in the pediatric population. The etiology is multifactorial, including genetic and environmental factors. The incidence is roughly equal between males and females, while there is a higher risk of progression in females. Guidelines for AIS treatment identify three levels of treatment: observation, physiotherapy scoliosis-specific exercises, and braces. In this paper, we carried out a review of the scientific literature about the indication and success rates of the braces provided for free by the National Health Service in Italy (SSN). Despite a general consensus on the efficacy of rigid bracing treatment and its use in AIS, an important heterogeneity about the treatment is present in the scientific literature, demonstrating a high degree of variability. The overall success rate of the braces provided by the SSN is high, suggesting an important therapeutic role in the treatment of AIS. Robust guidelines are needed to ensure uniform and effective treatments.
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Affiliation(s)
| | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, 80131 Naples, Italy;
| | - Mattia Giuseppe Viva
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, 00183 Rome, Italy; (M.G.V.); (M.M.)
| | - Massimiliano Murgia
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, 00183 Rome, Italy; (M.G.V.); (M.M.)
| | | | - Giovanni Barassi
- Center for Physiotherapy, Rehabilitation and Re-Education-CeFiRR-Gemelli Molise, 86100 Campobasso, Italy;
| | | | | | - David Perpetuini
- Department of Engineering and Geology, University “G. d’Annunzio” of Chieti-Pescara, 65127 Pescara, Italy;
| | | | - Serena Filoni
- I.R.R.C.S. Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Raffaello Pellegrino
- Department of Scientific Research, Campus Ludes, Off-Campus Semmelweis University, 6912 Lugano–Pazzallo, Switzerland;
- Santa Chiara Institute, 73100 Lecce, Italy
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9
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Qi X, Peng C, Fu P, Zhu A, Jiao W. Correlation between physical activity and adolescent idiopathic scoliosis: a systematic review. BMC Musculoskelet Disord 2023; 24:978. [PMID: 38115016 PMCID: PMC10729348 DOI: 10.1186/s12891-023-07114-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The multifactorial aetiology of scoliosis is well known. Physical activity is considered both a treatment and causative factor for idiopathic scoliosis; however, evidence for a causal relationship between physical activity levels and idiopathic scoliosis in adolescents is conflicting. Therefore, we aimed to summarise the current evidence regarding the association between adolescent idiopathic scoliosis and physical activity and further to assess whether the relationship is dose dependent. METHODS PubMed, Cochrane, Scopus, and Web of Science databases were searched from 1991 to July 2022 using the following main keywords: adolescent idiopathic scoliosis, physical activity, and risk factors, supplemented with manual searches, secondary citations, and reference searches. The quality of the included literature was evaluated using the Scale for Reporting Observational Studies in Enhanced Epidemiology guidelines. RESULTS Eight studies were included in this review, of which six reported an association between adolescent idiopathic scoliosis and physical activity levels and two reported no association. One British study reported reduced physical function early in life as a new risk factor for scoliosis onset. CONCLUSIONS Physical activity is strongly associated with adolescent idiopathic scoliosis. Physical activity should be encouraged as it plays an important role in the prevention of adolescent idiopathic scoliosis. Further research is needed to determine the dose-dependent relationship between physical activity and prevention of adolescent idiopathic scoliosis.
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Affiliation(s)
- Xiang Qi
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
- School of Physical Education, Taizhou University, Taizhou, China
| | - Chao Peng
- Department of Rehabilitation, The First Affliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Pinting Fu
- Department of Rehabilitation, Shanxi Acupuncture Hospital, Taiyuan, China
| | - Aiyuan Zhu
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Wei Jiao
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China.
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10
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Lau KKL, Law KKP, Kwan KYH, Cheung JPY, Cheung KMC. Proprioception-related gene mutations in relation to the aetiopathogenesis of idiopathic scoliosis: A scoping review. J Orthop Res 2023; 41:2694-2702. [PMID: 37203456 DOI: 10.1002/jor.25626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 05/20/2023]
Abstract
Since idiopathic scoliosis is a multifactorial disorder, the proprioceptive defect is considered one of its etiological factors. Genetic studies have separately revealed this relationship, yet it remains indeterminate which specific genes that related to proprioception contributed to the initiation, progression, pathology, and treatment outcomes of the curvature. A systematic search was conducted on four online databases, including PubMed, Web of Science, Embase, and Academic search complete. Studies were included if they involved human or animal subjects with idiopathic scoliosis and evaluated with proprioceptive genes. The search period was the inception of the database to February 21, 2023. Four genes (i.e., Ladybird homeobox 1 [LBX1], Piezo type mechanosensitive ion channel component 2 [PIEZO2], Runx family transcription factor 3 [RUNX3], and neurotrophin 3 [NTF3]) investigated in 19 studies were included. LBX1 has confirmed the correlation with the development of idiopathic scoliosis in 10 ethnicities, whereas PIEZO2 has shown a connection with clinical proprioceptive tests in subjects with idiopathic scoliosis. However, curve severity was less likely to be related to the proprioceptive genes. The potential pathology took place at the proprioceptive neurons. Evidence of proprioception-related gene mutations in association with idiopathic scoliosis was established. Nevertheless, the causation between the initiation, progression, and treatment outcomes with proprioceptive defect requires further investigation.
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Affiliation(s)
- Kenney K L Lau
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Karlen K P Law
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Kenny Y H Kwan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Jason P Y Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Orthopaedics and Traumatology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
- Department of Orthopaedics and Traumatology, The University of Hong Kong Shenzhen Hospital, Shenzhen, China
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11
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Yan LI, Wong AY, Cheung JP, Zhu B, Lee KC, Liang SR, Ll JY, Ho BYW, Bressington D. Psychosocial interventions for teenagers with adolescent idiopathic scoliosis: A systematic literature review. J Pediatr Nurs 2023; 73:e586-e593. [PMID: 37951727 DOI: 10.1016/j.pedn.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Psychosocial interventions can improve teenagers' self-esteem, mental health and bracing compliance. There is a need to compile available evidence of psychosocial care in adolescent idiopathic scoliosis. This systematic review aimed to identify and evaluate the effects of existing interventional studies of psychosocial care for the adolescent idiopathic scoliosis population. METHODS A comprehensive search of relevant literature published from the inception to March 2023 was conducted using nine databases. A google scholar search was performed on 1 July 2023, to update the searching results. Two reviewers independently assessed the methodological quality and extracted details of the included studies. Given the heterogeneity of the selected articles, the findings were synthesized narratively without conducting a meta-analysis. RESULTS Four randomized controlled trials reported in six articles involving 385 teenagers were included. The interventions appeared acceptable with high recruitment rates and low dropout rates reported. Psychosocial interventions had shown significant positive effects on postoperative pain, engagement in daily and social activities as well as brace use, coping abilities and anxiety. CONCLUSION Psychosocial interventions are generally feasible and acceptable among the adolescent idiopathic scoliosis population and have produced positive effects on a variety of physical and psychosocial outcomes. Study findings need to be interpreted with caution due to the limited number of available articles and the methodological concerns of the reviewed articles. PRACTICAL IMPLICATIONS Well-designed clinical trials are warranted in people from cultural backgrounds to develop and implement effective psychosocial interventions for teenagers with adolescent idiopathic scoliosis, not only for those at the post-surgery stage but also for those receiving conservative treatment.
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Affiliation(s)
- L I Yan
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong, SAR, China.
| | - Arnold Yl Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong, SAR, China
| | - Jason Py Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, 5/F Professorial Block, Queen Mary Hospital, Pokfulam, Hong Kong, SAR, China
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, 227 S Chongqing Rd, Shanghai, China
| | - Kit Ching Lee
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong, SAR, China
| | - Sui Rui Liang
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong, SAR, China
| | - Jia Ying Ll
- School of Nursing, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Hong Kong, SAR, China
| | - Bryan Ying Wai Ho
- School of Nursing and Health Studies, the Hong Kong Metropolitan University, Homantin, Kowloon, Hong Kong, SAR, China
| | - Daniel Bressington
- Faculty of Health, Charles Darwin University, Ellengowan Drive, Casuarina, NT 0810, Australia
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12
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Rudic TN, Althoff AD, Kamalapathy P, Bachmann KR. Surgical Site Infection After Primary Spinal Fusion Surgery for Adolescent Idiopathic Scoliosis: An Analysis of Risk Factors From a Nationwide Insurance Database. Spine (Phila Pa 1976) 2023; 48:E101-E106. [PMID: 36763825 DOI: 10.1097/brs.0000000000004591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE The purpose of this study was to quantify the incidence and factors associated with surgical site infection (SSI) in pediatric patients undergoing spinal fusion for adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA Infection is a morbid complication after spinal fusion. The incidence of SSI after pediatric spinal fusion is likely underestimated; the use of a national database allows for a comprehensive assessment of this rare outcome. MATERIALS AND METHODS The PearlDiver Database was used to identify AIS patients who underwent primary instrumented spinal fusion between 2010 and 2019 and relevant patient records were queried to identify infections within 7, 30, and 90 postoperative days. Patients with nonidiopathic scoliosis were excluded. Logistic regression was used to evaluate risk factors associated with postoperative infection. RESULTS Out of 9801 patients who underwent primary fusion for AIS, 44 patients (0.4%) developed an infection within 7 postoperative days. The 30 days and 90 days incidences were 1.9% and 2.7%, respectively. Within 90 days, 154 (57.7%) of the patients with infection had undergone reoperation, of whom 72 underwent multiple reoperations. Obesity and male sex ( P < 0.05) were significantly associated with postoperative infection. The length of fusion was not a significant factor in the development of SSI ( P > 0.05). Eleven patients underwent an operation requiring hardware removal within 90 days. There were no significant factors associated with those undergoing hardware removal compared with those undergoing surgical debridement. CONCLUSIONS The study identified a 2.7% 90 days incidence of SSI after posterior spinal fusion for AIS, with 57.7% of all infections requiring a return to the operating room. Preoperative patient-related characteristics associated with increased risk of postoperative SSI were male sex and obesity. The current study can be used to provide preoperative counseling regarding the risk of this postoperative complication. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Theodore N Rudic
- Department of Orthopedic Surgery, University of Virginia Health System, Charlottesville, VA
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13
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Moscinksi N, Sullivan PZ, Gokaslan ZL. Benign primary bone tumors, long-term management into adulthood. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2022.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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14
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Laubach L, Sharma V, Alsumait A, Chiang B, Kuester V. Socioeconomic Factors Correlation With Idiopathic Scoliosis Curve Type and Cobb Angle Severity. Cureus 2023; 15:e34993. [PMID: 36938294 PMCID: PMC10019979 DOI: 10.7759/cureus.34993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION Race and socioeconomic status correlate with disease outcomes and treatment in patients with idiopathic scoliosis (IS) to varying degrees, although there is no clear association with Cobb angle and curve type. The purpose of this study was to assess socioeconomic factors and their association with Cobb angles in patients with IS. METHODS A retrospective chart review was completed with the radiographic analysis of 89 patients diagnosed with IS and spinal curves >10° between the ages of six and 18. Associations between the Cobb angles and socioeconomic categorical variables were analyzed using a nonparametric Kruskal-Wallis test and continuous variables using a Spearman Rank correlation. Results: There were no significant associations between proximal thoracic, main thoracic, or thoracolumbar/lumbar Cobb angles and sex, insurance type, race, access to healthy food, financial difficulty, or income. BMI and proximal thoracic Cobb angle (ρ = 0.2375, p=0.0268) had a significant positive correlation, and BMI and income (ρ = -0.2468, p=0.0228) shared a significant negative correlation. CONCLUSIONS The severity of IS proximal thoracic Cobb angles was positively associated with BMI and income. Other socioeconomic factors such as age, race, sex, access to food, insurance, and financial difficulties related to scoliosis treatment were not correlated with Cobb angle severity. The data presented suggest that patients with IS have varying degrees of curve type and severity that overall do not correlate with various socioeconomic factors. Validating which factors are predictive of curve severity could lead to early intervention preventing further morbidity of IS.
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Affiliation(s)
- Logan Laubach
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Viraj Sharma
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Abdulaziz Alsumait
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Benjamin Chiang
- General Surgery, Riverside University Health System Medical Center, Riverside, USA
| | - Victoria Kuester
- Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, USA
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Koutras C, Shayestehpour H, Pérez J, Wong C, Rasmussen J, Tournier M, Nesme M, Otaduy MA. Biomechanical Morphing for Personalized Fitting of Scoliotic Torso Skeleton Models. Front Bioeng Biotechnol 2022; 10:945461. [PMID: 35928945 PMCID: PMC9343806 DOI: 10.3389/fbioe.2022.945461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/23/2022] [Indexed: 11/22/2022] Open
Abstract
The use of patient-specific biomechanical models offers many opportunities in the treatment of adolescent idiopathic scoliosis, such as the design of personalized braces. The first step in the development of these patient-specific models is to fit the geometry of the torso skeleton to the patient’s anatomy. However, existing methods rely on high-quality imaging data. The exposure to radiation of these methods limits their applicability for regular monitoring of patients. We present a method to fit personalized models of the torso skeleton that takes as input biplanar low-dose radiographs. The method morphs a template to fit annotated points on visible portions of the spine, and it relies on a default biomechanical model of the torso for regularization and robust fitting of hardly visible parts of the torso skeleton, such as the rib cage. The proposed method provides an accurate and robust solution to obtain personalized models of the torso skeleton, which can be adopted as part of regular management of scoliosis patients. We have evaluated the method on ten young patients who participated in our study. We have analyzed and compared clinical metrics on the spine and the full torso skeleton, and we have found that the accuracy of the method is at least comparable to other methods that require more demanding imaging methods, while it offers superior robustness to artifacts such as interpenetration of ribs. Normal-dose X-rays were available for one of the patients, and for the other nine we acquired low-dose X-rays, allowing us to validate that the accuracy of the method persisted under less invasive imaging modalities.
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Affiliation(s)
- Christos Koutras
- Department of Computer Science, Universidad Rey Juan Carlos, Madrid, Spain
- *Correspondence: Christos Koutras,
| | - Hamed Shayestehpour
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - Jesús Pérez
- Department of Computer Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Christian Wong
- Orthopedics Department, University Hospital of Hvidovre, Hvidovre, Denmark
| | - John Rasmussen
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | | | | | - Miguel A. Otaduy
- Department of Computer Science, Universidad Rey Juan Carlos, Madrid, Spain
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